Compassion fatigue may cripple health workers, expert says

Friday

When the burden of caring for others becomes too much to handle, the result can be more than just burnout.

Compassion fatigue can cause those in helping professions lose the ability to maintain a healthy balance of empathy and objectivity.

Psychologist Susan Fletcher will speak about compassion fatigue, also known as secondary traumatic stress disorder, at the Texas Tech Health Sciences Center School of Nursing on April 2.

Fletcher, from Plano, said compassion fatigue happens to people in a helping profession when they don't take care of themselves. They tend to do more than burn out, she explained.

Burnout is obvious, and compassion fatigue is subtle.

Oftentimes, people experiencing compassion fatigue begin to make mistakes, she said.

Nurses could give the wrong dose of medicine, or physicians could read something wrong on a chart.

"You know it's not normal when it interferes with their personal life," she said. "It interferes with their health, their personal life, their ability to do their job."

Compassion fatigue is common in professionals who are asked to do more with less, Fletcher explained. In the current state of the economy, she said, the susceptibility is startling.

Everyone in a helping profession is susceptible to compassion fatigue, from teachers, to administrators, to flight attendants, to financial advisors.

Numerous variables come into play as to why these professions experience compassion fatigue, she said. They deal with the public, or people who don't feel well. They're expected to diffuse situations, to help people get emotionally stabilized.

The result of untreated compassion fatigue could be what Fletcher calls an unscheduled breakdown.

"It's at the worse possible time, you just start losing it," she said. "You have an emotional outburst, over-sensitivity. You can do harm to yourself and others. You typically breakdown."

Recognizing signs

Dr. John Griswold, chairman of surgery at TTUHSC and the director of the burn center and trauma unit, said compassion fatigue is different for everyone.

In the area he works, it's more commonly seen in people who work in the burn center.

"The injuries are so disfiguring, and obviously are lifelong, plus the recovery time is drawn out over 12 to 18 months," he said. "The caregiver, whether the family, or a physician, who tends to be a cheerleader, ends up getting fatigued. ... They end up getting frustrated."

Health care providers know how to give compassion in a strong way in short bursts, Griswold said, but they can become frustrated because of a patient's lengthy recovery time.

Griswold said he notices compassion fatigue in his employees when they begin avoiding the patients, or figuring out a way to not go to a clinic appointment.

Griswold recalled feeling compassion fatigue when working with burned children. He felt uncomfortable, tense and anxious when he knew he was going to be around that patient.

Lisa Dillard, supervisor of the TTUHSC School of Nursing's Nurse-Family Partnership program, said she experienced compassion fatigue after being in a program that provided care to chronically ill and disabled children.

She was one of a small team of nurses and had no backup help. She was traveling to rural communities and would often go days without seeing or talking to another nurse.

Her supervisor kept giving her assignments, and she didn't decline because she wanted the families and children to have a good nurse. Dillard experienced weight gain, irritability and low energy. She was sleep deprived and cried easily.

"Over a long period of time, I really was going through the motions of just showing up. I had nothing left to give," she said. "I wasn't taking care of myself physically. An event occurred that woke me up, and I realized, 'I don't need to be here. I can't be here any more. I can't care for children and families like I did when I signed up.' ... I kind of jumped ship in my career and had to get out of that kind of caregiving."

Monica Garcia, a community health worker, or promotora, with the Patient Navigator Program at the Combest Center, said she has experienced signs of compassion fatigue multiple times. She feels distracted and drained, like she cannot focus on her work. At times, she locks herself in her room at home, not wanting to talk to or deal with her family members.

Sometimes she'll go to bed thinking about a patient, and wake up thinking about them - Do they have food to eat? Are they hot or cold? Did I do enough this week to help them?

"We may feel that anxiety; something may linger on our brains," she said. "We may take it home, even on weekends, certain things occur or certain situations, that even on the weekend, we're at home; we have time off; we're supposed to be resting, and it's still in the back of our minds."

Getting treatment

Fletcher suggests someone feeling signs of compassion fatigue take time to do an inventory of how they use their energy and attention. People should spend more time doing things that give them energy, not things that suck energy.

Dillard said it's the manager or supervisor's responsibility to screen and recognize burnout. Then, they need to encourage the staff member to look at what's going on at work and home, how they're handling those things and how the things may interfere in performing their job of taking care of others.

Personal counseling, exercise, diet, journaling and talking to a friend can help with compassion fatigue, Dillard said.

"The supervisor should encourage an environment that allows for debriefing when a nurse needs it, when she feels overwhelmed," she said.

Griswold said compassion fatigue can get better if it's recognized and talked about.

"You don't necessarily need a break, from the health care perspective," he said. "The family can need a break. ... We will help bring in a caregiver or sitter or attendant to give them a night out or a weekend off or something like that. The family member needs that, especially if the patient is home. That's a 24/7 thing; we can divorce ourselves from the patient."

Garcia said she's able to recognize her own compassion fatigue quickly. When she knows something is bothering her, she takes a step back and takes a breath.

She tells herself her expectations are too high. And when she needs further support, she turns to her team of four navigators and a supervisor. They meet every Friday to share their concerns and offer advice.

Changing culture

Fletcher said the culture needs to be improved to prevent compassion fatigue. Simple things like asking a coworker how their morning is, or encouraging an employee to take care of themselves can reduce the burden that leads to compassion fatigue.

"Don't be upset at people who take a lunch or go on a break," Fletcher said. "That doesn't mean they're a slacker, it means they're responsible."

Fletcher said in her profession, many psychologists and therapists burn out. Those who are the best at what they do can get burnt out, she said.

"We're losing the best in professions because they care too much, and we're not trained to balance," she said. "We're trained to produce."

Garcia said she is looking forward to Fletcher's presentation because compassion fatigue often is overlooked, yet it's common amongst health care providers.

She's hoping to get more examples of other ways to work through compassion fatigue.

"I think it would be helpful if supervisors, higher up people on the higher end, recognize it sooner and acknowledge it," she said. "Sometimes I feel like it's on the back burner. People know it's around, but if it is acknowledged more, maybe we can turn it around. ... I think it could affect the person that's doing this very important work. It happens at all levels. It may affect a person in their home life, their health, and people may decide they can no longer provide that service, and I think what we're doing is very important. We need it and the community needs it."

To comment on this story:

brittany.hoover@lubbockonline.com • 766-8722

leesha.faulkner@lubbockonline.com • 766-8706

Source: American Academy of Family Physicians

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